Preservation of periprosthetic bone with a collum-fixated short stem versus conventional metaphyseal-fixated stems in total hip arthroplasty: a randomized controlled trial with 2-year follow-up in 61 patients

Abstract

Background and purpose: We aimed to compare the effect of 2 femoral stem designs on periprosthetic bone mineral density (BMD) after total hip arthroplasty in a randomized controlled trial. We hypothesized that a short collum-fixated stem (Primoris) would better preserve proximal BMD than a conventional metaphyseal-fixated and diaphyseal engaging stem (Echo).
Methods: 61 patients with primary osteoarthritis were randomized to receive either the Primoris (n = 31) or Echo (n = 30) uncemented femoral stem. DXA scans were performed preoperatively, at 6 weeks, 12 months, and 24 months. The prespecified primary outcome was periprosthetic BMD at 24 months and patient-reported outcomes (EQ-5D, Oxford Hip Score, FJS-12) were collected preoperatively, and at each follow-up were secondary.
Results: At 24 months, model-based estimates showed significantly higher BMD in the Primoris group than in the Echo group in Gruen zones 3 (mean difference 0.40 g/cm², 95% confidence interval [CI] 0.26–0.53; P < 0.001), 5 (0.20 g/cm², CI 0.07–0.33; P = 0.003), and 7 (0.27 g/cm², CI 0.14–0.41; P < 0.001). These differences corresponded to relative differences of +19.1%, +9.1%, and +14.3%, respectively, compared with the Echo group. In addition, the increase in BMD from 6 weeks to 24 months was significantly greater in the Primoris group in Gruen zone 7 (mean difference in change 0.18 g/cm², CI 0.04–0.32; P = 0.01). PROMs improved similarly in both groups, with no statistically significant between-group differences.
Conclusion: At 2 years, the collum-fixated Primoris stem preserved more proximal femoral bone than the Echo stem, while PROMs were comparable between groups. The observed preservation of proximal bone stock may be advantageous for long-term bone maintenance and future revision surgery.